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I had a RP 6 months ago.  PSA of 4.9, Gleason of 3+3.  I went for the surgery because 6 of 12 samples came back positive and in one year the PSA went from 3.5 to 4.9. The biopsy I had was painless and the only problem was blood in the ejaculate (which went away in 3 weeks). After the operation the Gleason was 7 (I don't know the breakdown).  As long as you get the PSA checked yearly you should be able to stay on top of the problem and address it before it spreads.  In continence was barely an issue (5 weeks after the catheter was removed was all it took for continence to OK) ED is still around but I was told it would take a year for the nerves to heal. I had bilateral nerve sparing surgrey. All the info I read says to find the surgeon who does the most operations. (the guy I  had has over 5,000!)  I think that goes for who ever does the biopsy also.  Good Luck.

I am 67.  Gleason 4+3=7.  I had my prostate removed on 3/20/2018.  My choice was made when the upper left apex of the prostate started to push on the bladder.  The pathology after surgery looks like it was contained.  If you like reading that kind of stuff, pleaae look at my Description of procedure RP 3/20/2018 on this site. It gives a pretty good picture of the surgery.  Looks like you have time to look at a lot of options.  Did you have a MRI before your biopsies?  Hope this helps.

I am now starting the 10th year of Active Surveillance.

There is a man who staarted in the AS program where I am treated when he was still in his thirties. I think that this was about 15 years ago. since then, he and his wife have had a child.

There is a difference between biopsy capability. Now there are sophisticated biopsies that are available, that is a MRI guided biopsy to a three dimensional biopsy machine, so one can have more confidence in the outcome, and since this type biopsy is much better than a random ultrasound that is done in most doctors offices, one can have a biopsy less frequently.

All active treatments have the potential of major side effects, and YOU as a relatively young man would have to suffer these consequences for a long, long time.

Studies have shown that Gleason 6's do not metatasize, that is go outside the capsule; only in the case where there is a lot of 6...in those cases there may be a Gleason 4 that is  hiding

Here is a thread that i suggest you read...please pay careful attention to the comment that ASAdvocate made.

https://csn.cancer.org/node/315522

I for one plan to continue with AS the rest of my life which is highly possible without any side effects of active treatment. Autopsy studies indicate that many men die with, not because of prostate cancer...google autopsy study prostate cancer detroit

I suggest that you attend local support groups, ustoo sponsors local groups worldwide, for info. Research, read books, etc.

sso far you have had five years of quality life,,,,,,keep it up.

Best

Hi Hunt,

It basically breaks down into two treatment options or continue on AS.  Surgery is a valid option but can have varied amount of side effects sometimes good, sometimes bad.  If you want to go the surgery route make sure you pick a surgeon that has performed hundreds-thousands of RP's to make sure you leverage the surgeons knowledge & expertise.  I had Davinci surgery back in 2014 and it took me about 1.5 years to get back to "normal" from the ED with constant improvement over that 1.5 yr. timeframe.  I still have a slight stress urine leakage that I wear a light pad for daily just to catch the dribbles when I move wierd or strain. But ya know I sleep very well at night knowing(I hope) the cancer is out of my body.  I did not want to wait months to years with radiation doing the slow PSA decline or the possible risks of future side effects.  But thats just me.  Some people from surgery or radiation have remarkable recoveries with very little side effects and other have permanent Ed or leakage.  Again I think a lot of that depends on the amount of cancer they have to carve out of you and the skill of the surgeon.

Radiation usually has fewer side effects during treatment but can have latent side effects, bowel lesions, bladder problems, or later on in life cancers due to the radiation beam hitting non cancerous tissue and altering it's cell structure.  As with surgery the results vary with almost no problems to major ones later on.

AS as you know requires repeated biopsy's while the cancer is still inside your body, something I did not like or want. Other men thinks it's OK and they will die of something else before the cancer progresses, valid point depending on the agressiveness and your age.

You need to study the side effects and discuss with your family and doctors to find the best treament options for you.  There is no correct best choice to remove the cancer but you must understand the risks for each treament method.  I would recommend that you go to the websites of the manufactures that make the treatment machines(Cyberkife, Davinci) and study the risks, at 3+3 you have time to do a good job on your homework that will lead you to YOUR correct choice.  Don't let people sway you by putting down one or more of the treament methods, you need to decide for yourself. It's your body and yu must live with the results.   Good luck in your journey, if you have more questions let us know, there is a lot of experiece in this message board for all of the various treatment options.

Dave 3+4